Provider Demographics
NPI:1659588630
Name:BRIDGING ALLIANCE, LLC
Entity Type:Organization
Organization Name:BRIDGING ALLIANCE, LLC
Other - Org Name:FOOT SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BERRIZBEITIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-569-5188
Mailing Address - Street 1:3000 OLD ALABAMA RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-5860
Mailing Address - Country:US
Mailing Address - Phone:770-569-5188
Mailing Address - Fax:770-569-5187
Practice Address - Street 1:3000 OLD ALABAMA RD
Practice Address - Street 2:SUITE 111
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022
Practice Address - Country:US
Practice Address - Phone:770-569-5188
Practice Address - Fax:770-569-5187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA332BC3200X332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5938680001Medicare NSC